LA-ACC Annual Meeting October 26-27, 2018 · LA-ACC Annual Meeting October 26-27, 2018 ... Daniel...

2018 LA-ACC Meeting with ISLA Breakoutwww.laacc.org • 504-841-0145 office • 504-335-2266 fax • [email protected] email1

Final Program

LA-ACC Annual Meeting

October 26-27, 2018 Loews Hotel • New Orleans, LA

Chairs Ali “Zee” Murtuza MD, FACC Sangeeta Shah MD, FACCJherie Ducombs MD, FACCDaniel Morin MD, FACC

CV Team Moriah Richie PA-C, MHSKristen Dupre Pharm DTodd Mule

2018 LA-ACC Meeting with ISLA Breakoutwww.laacc.org • 504-841-0145 office • 504-335-2266 fax • [email protected] email 2

STAY CONNECTED! LouisianaACC @LA_ACC LAACC.org



Event Summary with Locations

Friday, October 26, 2018

Saturday, October 27, 2018

1:00pm-5:00pm

CV Administrative Summit

LaFourche/Pointe Coupee

9th floor


Louisiana Ballroom

10th Floor

Louisiana Ballroom Trainee Research Competition Oral Abstract Presentations pages 11-13

Louisiana Ballroom Honorable Mention Abstracts pages 14-15

Visit the Exhibitors in Parish Hall All Day

3:00pm-5:00pm

Women in Cardiology Event

St. Landry- 9th Floor

ISLA Breakout

Feliciana Ballroom

10th Floor

Breakouts

St. Landry

9th Floor

5:00pm-7:00pm Poster Abstracts Online at www.laacc.org

5:00pm-7:00pm

Happy Hour & Poster Display

Foyer Area- 9th Floor

Lunch

Louisiana Ballroom

10th Floor





JOINT SPONSORSHIP STATEMENT

This activity has been planned and implemented in accordance with the Accreditation Requirements and Descriptions of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Woman’s Foundation and The Louisiana Chapter American College of Cardiology. The Woman’s Foundation is accredited by the LSMS to provide continuing medical education for physicians.

The Woman’s Foundation designates this live activity for a maximum of 15.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Friday, October 27, 2018 Saturday, October 28, 2018CV Administrative Summit = 3.75 hours LA-ACC Annual Meeting = 4.5 hoursWomen in Cardiology = 2 hours ISLA Breakout = 4.75 LA-ACC Breakouts = 1.75 hours

DISCLOSURE/DISCLAIMER

In accordance with Woman’s Foundation’s policy, all committee, planning, and faculty members have signed a conflict of interest statement in which they have disclosed any significant financial interests or other relationships with industry relative to topics they will discuss at this program. At the beginning of the program, faculty members are expected to disclose any such information to participants. Such disclosure allows you to evaluate better the objectivity of the information presented in lectures.

PCSK9 INHIBITOR PRESENTATION- CONTINUING MEDICAL EDUCATION

PROGRAM OVERVIEWBetween 3.5 and 15 million Americans with hypercholesterolemia are eligible for PCSK9 inhibitor therapy. This activity will review the latest evidence supporting the use of PCSK9 inhibitors for the management of at-risk patients with hypercholesterolemia and secondary prevention of cardiovascular events, and will provide practical guidance for utilizing PCSK9 inhibitors in patients who can benefit from them the most. JOINT ACCREDITATION STATEMENTIn support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Spire Learning. Postgraduate Institute for Medicine is jointly accredited by the American Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Attendees who participate in this PCSK9 inhibitor presentation will receive AMA PRA Category 1 Credit(s)™, free of charge, through the joint providership of The Postgraduate Institute for Medicine and Spire Learning.

CME Information





CONTINUING MEDICAL EDUCATION (CME CREDITS)

PCSK9 INHIBITOR PRESENTATION• Attendees will need to complete a pre- and post-assessment/evaluation, and turn these in at the end of the

presentation to a Spire Learning representative who will be onsite.• Spire will send the completed forms to our Joint Provider, and they will send a CME certificate to each

attendee within 3 weeks of the meeting.

CONTINUING MEDICAL EDUCATION (CME CREDITS)

CV Administrative Summit, Women in Cardiology, LA-ACC Annual Meeting & Breakouts, and the ISLA Breakout• Complete the CME Credit Form and return to the Registration Desk.

This will assist us in claiming your CME for the Annual Meeting• You will receive an email about two weeks after the meeting from Ashely Lambert at the Woman’s Foundation.• Complete the online evaluation to receive your CME certificates.• Please confirm your email at the registration desk.• Questions? Please email Janna at [email protected].

ASE CEU CREDITS

The ISLA Breakout has been approved for x hours of ASE CEU Credits.

ISLA Breakout• Don’t forget to complete and submit the online evaluation to receive your ASE CEU credits.• You must complete the evaluation by November 27, 2018• Certificates will be emailed by November 28, 2018• You can find the evaluations on the ISLA website www.lacvimaging.org. • It’s under the ISLA Meetings tab - the page is called Meeting Evaluation.

How to Claim Your Continuing Education Credits





LISA BIENVENU, RDCS, ACS, FASE Echocardiography Lab - Technical DirectorOchsner Health System

JUSTIN CAUDLEDirector, Healthcare Policy and AdvocacyJohnson & JohnsonHealth Care Systems Inc

KENNETH CIVELLO, JR, MD, FACCClinical Cardiac ElectrophysiologyOur Lady of the Lake

DAVID DALY, MD, FACCInterventionalist CardiologistCardiology Specialists of Acadiana

JHERIE DUCOMBS, MD, FACCAssistant Chief Medical OfficerNorth Oaks Health Systems

LAURA FULLER, PharmD, BCPSClinical Pharmacy Specialist, CardiologyOchsner Health System

LINDA GATES-STRIBY, CCS-P, ACS-CAPrincipalGates Physician Services

EYAL HERZOG, MDDirector Cardiac Care UnitDirector Echocardiography Laboratories Mount Sinai, St. Luke’s Hospital Professor of MedicineIcahn School of Medicine at Mount Sinai

AHMAD JABBAR, MDCardiology FellowTulane School of Medicine

NEERAJ JAIN, MD, FACC Associate Professor of Clinical Medicine DirectorCardiology FellowshipLSU Health – New Orleans

SCOTT LAURA, MDCardiology FellowLSU Health New Orleans

ELIZABETH F MCILWAIN, MHS, RCS, FASE Operations Coordinator for Cardiology Services West Jefferson Medical Center

PRAMOD MENON, MD, FACCCardiovascular Disease and Interventional CardiologyLouisiana Heart Center

PRADEEP NAIR, MD, FACCInterventionalist CardiologistCardiovascular Institute of the South

INDY NEBEKERExecutive CoachEmpowerment Coaching

HAMANG PATEL, MD, FACCCardiomyopathy and Heart TransplantationOchsner Health System

MARLOE PRINCE, MDCardiology FellowOchsner Health Systems

MEHNAZ RAHMAN MDCardiology FellowLSU Health New Orleans

STEPHEN RAMEE, MD, FACCMedical Director, Structural and Valvular Heart Center Interventional Cardiology and Peripheral Vascular InterventionOchsner Health System

KELLY SHUM, MDCardiology FellowOchsner Health Systems

SANGEETA SHAH, MD, FACCDirector, Cardiovascular MRI at Ochsner Heart & Vascular InstituteCo-Director, Adult Congenital Heart ProgramOchsner Health System

SABRINA WHITE, NPHeart Failure ClinicEast Jefferson General Hospital

2018 Faculty





FRIDAY, OCTOBER 26, 2018 5:00pm-7:00pmFoyer Area- 9th Floor

Poster #1a Honorable MentionPOSITRON EMISSION TOMOGRAPHY ABSOLUTE STRESS MYOCARDIAL BLOOD FLOW FOR RISK STRATIFICATION IN NONISCHEMIC CARDIOMYOPATHYPoster Presenter: Thomas Middour, MD, Ochsner Health SystemNew Orleans, LA

Poster #1b Honorable MentionRELATIONSHIPS BETWEEN MYOCARDIAL SCAR ON CARDIAC MAGNETIC RESONANCE IMAGING AND ELECTROCARDIOGRAPHIC VENTRICULAR DEPOLARIZATION AND REPOLARIZATIONPoster Presenter: Abdulaziz Joury MD, Ochsner Health System, New Orleans, LA

Poster #1cA SYSTEMATIC REVIEW OF PHARMACOLOGICAL INTERVENTIONS FOR PREVENTION OF CHEMOTHERAPY INDUCED CARDIOMYOPATHY PAIRWISE AND NETWORK META-ANALYSISPoster Presenter: Magdy Hanna MD, LSU Health Shreveport, Shreveport, LA

Poster #2aMIND OVER MATTER: ASSOCIATIONS BETWEEN PAIN AND CARDIORESPIRATORY FITNESSPoster Presenter: Sergey Kachur MD, Ochsner Health System, New Orleans, LA

Poster #2bOUTCOMES OF CHRONIC RESYNCHRONIZATION THERAPY (CRT) WITH OR WITHOUT A DEFIBRILLATOR IN CHRONIC HEART FAILURE PATIENTS - AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS.Poster Presenter: Parinita Dherange MD, LSU Health Shreveport, Shreveport, LA

Poster #2cQUALITY CARE ANALYSIS OF THE APPROPRIATENESS OF VA CARDIOLOGY CLINIC VISITSPoster Presenter: Ayush Motwani MD, Tulane School of Medicine, New Orleans, LA

Poster #2dTHE LONG-TERM CARE OF ADULT CONGENITAL HEART DISEASE PATIENTS: A SURVEY-BASED STUDYPoster Presenter: Danielle Hatt MSIV, Ochsner Health System, New Orleans, LA

2018 Poster Display POSTER JUDGESLSU Health New Orleans: Neeraj Jain, MDLSU Health Shreveport: Paari Dominic Swaminathan MDOchsner Health Systems: Selim Krim, MDTulane School of Medicine: Rohan Samson MD





Poster #3aARRHYTHMIAS IN HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS: SHOULD WE WORRY?Poster Presenter: Ahmad Al Turk MD, Tulane School of Medicine, New Orleans, LA

Poster #3bCOMPLEX CORONARY INTERVENTION IN A PATIENT WITH VON WILLEBRAND DISEASE; NOVEL USE OF VWF/FVIII CONCENTRATES SUPPLEMENTATION PRIOR TO PROCEDUREPoster Presenter: Ahmad Al Turk MD, Tulane School of Medicine, New Orleans, LA

Poster #3cA SUCCESSFUL CONGESTIVE HEART FAILURE MANAGEMENT PROGRAM: QUALITY IMPROVEMENT INITIATIVE BY INTERNAL MEDICINE RESIDENTSPoster Presenter: Naga Sai Shravan Turaga MD, LSU Health New Orleans, Lafayette, LA

Poster #3d USE OF DIRECT-ACTING ORAL ANTICOAGULANTS FOR LEFT VENTRICULAR THROMBUSPoster Presenter: Stephanie Elagizi PharmD, Ochsner Health System, New Orleans, LA

Poster #4aAN UNUSUAL ETIOLOGY OF CHEST PAIN IN A YOUNG PATIENTPoster Presenter: Naga Sai Shravan Turaga MD, LSU Health New Orleans, Lafayette, LA

Poster #4bSPONTANEOUS PNEUMOTHORAX WITH PNEUMOMEDIASTINUM AFTER DUAL CHAMBER PACEMAKER PLACEMENTPoster Presenter: Jonathan Massey MD, LSU Health Shreveport, Shreveport, LA

Poster #4cA RARE CASE OF ADULT CONGENITAL HEART DISEASE: SINGLE VENTRICULAR CHAMBER WITH ANOMALOUS RIGHT CORONARY ARTERYPoster Presenter: Muhammad Shabbir Rawala MD, Rapides Regional Medical Center, Alexandria, LA

Poster #4dATRIAL MYXOMA MIMICKING MITRAL VALVE STENOSIS LEADING TO PULMONARY HYPERTENSIONPoster Presenter: Muhammad Shabbir Rawala MD, Rapides Regional Medical Center, Alexandria, LA

Poster #5aACUTE ST-ELEVATION MYOCARDIAL INFARCTION SECONDARY TO CORONARY VASOSPASM IN AN ADOLESCENT USING ANABOLIC-ANDROGENIC STEROIDSPoster Presenter: Abdulaziz Joury MD, Ochsner Health System, New Orleans, LA

Fellow Posters

2018 Poster Display





Poster #5bA CASE OF TRANSIENT CORTICAL BLINDNESS FOLLOWING CARDIAC CATHETERIZATIONPoster Presenter: Stefan Sicinschi MD, LSU Health Shreveport, Shreveport, LA

Poster #5cSTRESS CARDIOMYOPATHY FOLLOWING INTRAVENOUS EPINEPHRINE ADMINISTRATIONPoster Presenter: Tasleem Katchi MD, Tulane School of Medicine, New Orleans, LA

Poster #5dSUCCESSFUL REPAIR OF A LARGE ABDOMINAL AORTIC ANEURYSM USING AN ENDOVASCULAR APPROACHPoster Presenter: Tasleem Katchi MD, Tulane School of Medicine, New Orleans, LA

Poster #6aA RARE CASE OF GIANT LEFT ATRIUMPoster Presenter: Nakhle MD, Tulane School of Medicine, New Orleans, LA

Poster #6bA RARE PRESENTATION OF SYNTHETIC MARIJUANA USE AND SUBSEQUENT DOUBLE INFARCTION OF THE RIGHT CORONARY ARTERY AND LEFT CORONARY ARTERY THROMBOTICPoster Presenter: Edward Ladyzhenskiy MD, LSU Health New Orleans, New Orleans, LA

Poster #6cANOMALOUS LEFT CORONARY ARTERY ARISING FROM THE NON-CORONARY CUSPPoster Presenter: Carolina Larmeu MD, Our Lady of the Lake Children’s Hospital, Pediatric Residency Program, Baton Rouge, LA

Poster #6dCASE OF ELDERLY PATIENT WITH VENTRICULAR SEPTAL DEFECTPoster Presenter: Mehnaz Rahman MD, LSU Health New Orleans, New Orleans, LA

Poster #7aCHEMOTHERAPY INDUCED PERICARDITISPoster Presenter: Tejas Joshi MD, LSU Health New Orleans, LA

Poster #7bDESPERATE TIMES REQUIRE DESPERATE MEASURES: A PATIENT PRESENTING WITH LEG PAINPoster Presenter: Solomon Seifu MD, LSU Health New Orleans, New Orleans, LA

2018 Poster Display





Poster #7cLEFT CIRCUMFLEX GIANT CORONARY ARTERY ANEURYSM WITH INTRALUMINAL THROMBUSPoster Presenter: Aditya Hendrani MD, LSU Health Shreveport, Shreveport, LA

Poster #7dLEFT ATRIAL POSTERIOR WALL THROMBUS AFTER POSTERIOR WALL ABLATIONPoster Presenter: Shourjo Chakravorty MD, Ochsner Health System, New Orleans, LA

Poster #8aDRUG-RELATED COMPLETE ATRIOVENTRICULAR BLOCKADE CAUSED BY DILTIAZEMPoster Presenter: Ryley McPeters MD, LSU Health New Orleans, New Orleans, LA

Poster #8bDOUBLE DE NOVO RECURRENT SPONTANEOUS CORONARY ARTERY DISSECTIONPoster Presenter: Lina Ya’qoub MD, LSU Health Shreveport, Shreveport, LA

Poster #8cEUSTACHIAN VALVE ENDOCARDITIS: TO TEE OR NOT TO TEE?Poster Presenter: Hanyuan Shi MD, Tulane School of Medicine, New Orleans, LA

Poster #8dHYPERTROPHIC CARDIOMYOPATHY MASQUERADING AS CRITICAL AORTIC STENOSIS IN A PATIENT WITH BICUSPID AORTIC VALVEPoster Presenter: Avaneesh Jakkoju MD, LSU Health New Orleans, New Orleans, LA

Poster #9aLIMITATIONS OF ECHOCARDIOGRAPHY IN EVALUATING RIGHT ATRIAL THROMBUSPoster Presenter: Ala Mohsen MD, LSU Health New Orleans, New Orleans, LA

Poster #9bMECHANICAL CIRCULATORY SUPPORT IN THE SETTING OF CARDIOGENIC SHOCK FROM TAKOTSUBO CARDIOMYOPATHYPoster Presenter: Tariq Yousuf MD, Tulane School of Medicine, Metairie, LA

Poster #9cPREGNANCY MANAGEMENT IN A PATIENT WITH CONGENITAL HEART DISEASE WITH SEVERE RV TO PA CONDUIT STENOSIS AND REGURGITATIONPoster Presenter: Sajan Gill BS, Ochsner Health System, New Orleans, LA

2018 Poster Display





Poster #9dPREGNANT WITH INFECTIVE ENDOCARDITIS OF UNKNOWN ETIOLOGYPoster Presenter: Rebecca Lee DO, LSU Health New Orleans, Lafayette, LA

Poster #10aPREMATURE CORONARY ARTERY DISEASE IN SETTING OF PROBABLE FAMILIAL HYPERCHOLESTEROLEMIAPoster Presenter: Christen Harris MD, New Orleans, LA

Poster #10bRARE CAUSE OF STEMI IN PROSTHETIC VALVE ENDOCARDITISPoster Presenter: Shashitha Gavini D.O., LSU Health New Orleans, Lafayette, LA

Poster #10cREVERSIBLE CARDIOMYOPATHY AND CRITICAL HYPOPHOSPHATEMIA: A CAUTIONARY TALE OF OVER THE COUNTER DIURETICSPoster Presenter: John Spitzer MD, Tulane School of Medicine, Internal Medicine, New Orleans, LA

Poster #10dTHE USE OF TORSEMIDE IN THE ERA OF HIGH VALUE CAREPoster Presenter: Neal Dixit BS, Tulane School of Medicine, New Orleans, LA

Poster #11aUSE OF A PERIPHERAL STENT IN A LARGE RCA THROMBOTIC LESIONPoster Presenter: Paul Katigbak MD, Tulane School of Medicine, New Orleans, LA

Poster #11bUTILITY OF RECOGNIZING EARLY EKG CHANGES IN A SUBTYPE OF TAKOTSUBO CARDIOMYOPATHY IN THE SETTING OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATION: A CASE REPORTPoster Presenter: Maria Khan DO, LSU Health Shreveport, Internal MedicineShreveport, LA

2018 Poster Display





1:00pm-1:20pmNON-INVASIVE SURVEILLANCE OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH EXERTIONAL DYSPNEA Sunayana Udaya Kumar MBBS, Mehnaz Rahman MD, Joshua Grant MD, Frank Smart MD Presenter: Sunayana Udaya Kumar MBBS, LSU Health-New Orleans, New Orleans, LA

BackgroundDiastolic heart failure ( HFpEF) is characterized by fluid retention with preserved left ventricular systolic function. Patients’ primary complaints of exertional dyspnea usually precede overt clinical correlates of volume however. There is a paucity of evidence directed medical therapies for HFpEF, prevention and early detection remain the most important tools in armamentarium. We investigate simple non invasive maneuvers that supplement routine transthoracic echo which could narrow the differential for this rather non-specific presenting symptom. Echo parameters at rest in a relative euvolemic state may not be sensitive enough to establish HF as the diagnosis.

ObjectiveTo investigate additional diagnostic value of incorporating leg compression or passive leg raise in affecting diastolic parameters on routine transthoracic echo in patients referred for exertional dyspnea.

MethodsAdults presenting to University Medical Center with primary symptom of dyspnea on exertion and without existing diagnosis of heart failure, systolic or diastolic with an order for a baseline transthoracic echo (TTE) were randomized in a one to one fashion to either leg compression or passive leg raise if their baseline echo was normal. Protocol for both maneuvers was standardized and w consistently followed by both sonographer and supervising nurse. TTE was repeated to evaluate significant change in pre-specified parameters. Covariates were selected on a basis of clinical relevance to HFpEF- Age, Sex, BMI, presence of DM.

Results (if relevant)There was a statistically significant difference in e’ velocity between patients at rest and with either stress maneuver however no difference between the modalities themselves. 10 out of the 40 patients were reclassified as having diastolic dysfunction based on change in E/e’ >14 . Compared to standard process, this added an average of seven extra minutes to total procedure time. There was no significant difference in baseline characteristics between groups.

Conclusion Heart failure with diastolic dysfunction is associated with a wide spectrum of co-morbidities with heterogenous disease mechanisms. This partially explains the divergent response to therapies between this syndrome and heart failure with systolic dysfunction. Until we are able to identify targeted therapeutic options, we will focus on prevention and symptom management. Studies show that the clinical course after the initial hospitalization for heart failure is associated with a mortality risk up to 3 fold higher than in patient’s never hospitalized. Timely medical intervention is paramount in delaying and perhaps preventing hospitalizations.

This prospective study suggests that passive leg raise and leg compression can identify subclinical impairments in diastolic function without requiring significant additional training, equipment or time.

In the next phase of this study, we hope to increase our sample size and incorporate secondary objective measures such as strain analysis and HFpEF specific biomarkers to support our preliminary findings.

Trainee Research Competition Oral Abstract Presentations





1:20pm-1:40pmMEAN TRANSMITRAL FLOW RATE IN PATIENTS WITH DEGENERATIVE MITRAL STENOSIS Russell Riehl MD, Zahoor Khan MD, Vinod Chainani MD, Michael E. Cash MD MPH, Sangeeta Shah MD, Daniel P. Morin MD MPH, Yvonne E. Gilliland MD, Salima Qamruddin MD MPH Presenter: Russell Riehl MD, Ochsner Health System, New Orleans, LA

BackgroundDegenerative mitral stenosis (DMS) is chronic non-inflammatory degeneration and calcification of the mitral valve. Current guidelines define severe mitral stenosis (MS) as mitral valve area (MVA) ≤1.5 cm2 and very severe MS as MVA ≤1 cm2. Echocardiographic tools used to define stenosis severity have been validated in rheumatic mitral stenosis (RMS), but not in DMS. We previously showed that mean transmitral gradients do not correlate well with stenosis severity in DMS. As mean transvalvular gradient is directly proportional to the square of transvalvular flow, a difference in flow may explain our previous observations.

ObjectiveIn the present study, we sought to: a) evaluate the differences in transmitral flow rates in DMS and RMS, b) define the relationship between transmitral flow rate and MVA according to stenosis severity, and c) investigate the relationship between mean gradient and MVA in DMS and low left ventricular (LV) stroke volume (defined as ≤35ml/m2).

Methods64 patients with DMS and 24 with RMS (77±12 vs. 59±14 y, p=0.001) were reviewed. Eligible patients had at least mild MS and a mean gradient of ≥4 mmHg. Patients with LV ejection fraction

Results (if relevant)Mean transmitral flow rate was significantly higher in DMS vs. RMS (171±47 vs 141±69 ml/s, p=0.021). There was a weak but significant correlation between mean gradient and mean transmitral flow rate (r=0.38, p=0.01) in DMS. Patients with MVA ≤1.0 cm2 and MVA >1.5 cm2 had significantly different flow rates (197±40 vs 137±45 ml/s; p=0.001). Mean transmitral flow rate ≤149 ml/sec predicted MVA ≤1.0 cm2 with 75% sensitivity and 83% specificity (AUC=0.77, p=0.003), while a rate ≤190 ml/s predicted MVA ≤ 1.5 cm2 with 83% sensitivity and 59% specificity (AUC=0.72, p=0.007). LV stroke volume ≤35 ml/m2 was observed in 45% of DMS patients and 42% of RMS patients (p=0.079). In these patients with low LV stroke volume, mean flow rate remained significantly higher among DMS patients than in those with RMS (143±36 vs 109±52 ml/s, p=0.026).

ConclusionMean transmitral flow rate is significantly higher in DMS than RMS. Mean gradients do not correlate strongly with MS severity in DMS. For patients with DMS, the mean transmitral flow rate may be a better surrogate for stenosis severity than the mean gradient.






1:40pm-2:00pmASSOCIATIONS OF PAIN AND MORTALITY FOLLOWING CARDIAC REHABILITATION Sergey Kachur MD, Rebecca Morera MD, Alban Deschutter MD, Carl J Lavie MD, Richard Milani MD Presenter: Sergey Kachur MD, Ochsner Health System, New Orleans, LA

BackgroundThe beneficial effects of cardiac rehabilitation (CR) on mortality in patients with stable coronary heart disease (CHD) have been well-documented, whereas the phenomenon of pain and its effects remain poorly understood. The current study examines the relationship between reported pain level and mortality outcomes following CR.

ObjectiveDetermine whether pain levels influence mortality after CR.

Methods1110 subjects with stable CHD referred for CR between 01/2000 and 06/2013 with a mean follow-up of 6.3 years were evaluated for pain perception using the Short-Form 36-health questionnaire before and after CR. Associations between a pain threshold (cut-off established through receiver-operating curve analyses) and mortality were examined in the setting of previously established predictors of mortality in this cohort (age, sex, ejection fraction, baseline cardiorespiratory fitness, and psychosocial stress levels) using univariate and multi-variate hazard regression models.

Results (if relevant)Post-CR pain was a significant adjusted predictor of mortality (p=0.04, Figure 1). When taking pain into account, psychosocial stress and gender differences were no longer significant predictors (p=0.13 and p=0.56 respectively). A higher number of males in comparison to females reported a “low” pain score (51% vs. 40%; p=0.001), however difference in means was non-significant.

ConclusionPain is a significant adjusted predictor of mortality that may underlie changes in mortality outcomes attributed to gender and other psychosocial stress. Further study into pain and its effects on outcomes during and after CR is warranted.






POSITRON EMISSION TOMOGRAPHY ABSOLUTE STRESS MYOCARDIAL BLOOD FLOW FOR RISK STRATIFICATION IN NONISCHEMIC CARDIOMYOPATHYThomas G. Middour MD, Todd M. Rosenthal MBBS, Freddy M. Abi-Samra MD, Michael L. Bernard MD PhD, Sammy Khatib MD, Glenn M. Polin MD, Paul A. Rogers MD PhD, Robert M. Bober MD, Daniel P. Morin MD MPHPresenter: Thomas Middour MD, Ochsner Health System, New Orleans, LA

BackgroundSudden cardiac death is a substantial cause of mortality in patients with cardiomyopathy, but evidence supporting im-plantable cardioverter defibrillator (ICD) implantation is less robust in those with nonischemic cardiomyopathy (NICM). Absolute quantification of stress myocardial blood flow (sMBF) measured by positron emission tomography (PET) may predict adverse cardiac events.

ObjectiveWe assessed whether sMBF predicts future ventricular arrhythmias (VA) and/or death in patients with NICM.

MethodsWe prospectively followed patients with NICM (LVEF≤35%) and an ICD who underwent cardiac PET stress imaging with sMBF quantification. NICM was defined as absence of angiographic obstructive coronary stenosis, significant rela-tive perfusion defects on imaging, and prior coronary revascularization or acute coronary syndrome. Endpoints were appropriate device therapy (VA) and all-cause mortality. Subgroup analysis was performed in patients who had no prior history of VA (i.e., the primary prevention population).

Results (if relevant)Patients (60±14 years, 46% male) were followed for 41±23 months. sMBF predicted VA both in the whole population (HR per 1 mL/g/min:0.17, P=0.015) and in the primary prevention population (HR 0.13, P=0.049). Patients with sMBF below the median had significantly more VA than those above the median, both in the whole population (P=0.004) and in the primary prevention population (P=0.046). Estimated 3-year VA rates were 67% vs. 13% and 39% vs. 8%, respectively. sMBF did not predict death.

ConclusionIn patients with NICM, lower sMBF as measured by cardiac PET predicts VA. This relationship may be useful for risk stratification and decision making regarding ICD implantation.

Honorable Mention





RELATIONSHIPS BETWEEN MYOCARDIAL SCAR ON CARDIAC MAGNETIC RESONANCE IMAGING AND ELECTROCARDIOGRAPHIC VENTRICULAR DEPOLARIZATION AND REPOLARIZATION Abdulaziz Joury MD, Peter Pantlin BS, Ronald Chong-Yik MD MPH, Sangeeta B. Shah MD, Joel Xue PhD, Daniel P. Morin MD MPH Presenter: Abdulaziz Joury MD, Ochsner Clinic Foundation, New Orleans, LA

BackgroundECG markers of ventricular depolarization and repolarization (D/R; e.g., QRS duration, QT, Tpeak-Tend [Tpe]) correlate with risk of sudden cardiac arrest. Similarly, myocardial scar on cardiac magnetic resonance (CMR) imaging correlates with ventricular arrhythmias. Whether D/R markers correlate with scar burden is unknown.

ObjectiveTo identify the relationship between ventricular D/R and left ventricular (LV) scar burden on CMR.

MethodsPatients without coronary artery disease (CAD) (i.e., no MI history, stent placement, CABG, or significant stenosis in epi-cardial vessels) underwent CMR with analysis of LV myocardial scar via late gadolinium enhancement (LGE). ECGs done within 3 months of CMR were automatically analyzed and manually overread. We assessed the correlation between D/R markers and scar burden on CMR.

Results (if relevant)There were 35 patients (49% M, 41±20 Y, LVEF 56±12%). Indications for CMR were to rule out: ARVC (16), infiltrative cardiomyopathy (6), hypertrophic cardiomyopathy (5), myocarditis (4) or other (4). No patient had positive CMR for the diagnosis in question. The mean QRSd was 92±15 ms, Tpe was 104±16 ms, and QT was 399±39 ms. Mean LVEF:56%. There was positive correlation between total volume of LV scar and Tpe (r=0.4, p=0.013) and QT (r=0.42, p=0.012), and between relative scar volume and Tpe (r=0.51, p=0.002) and QT (r=0.39, p=0.022). However, there was no correlation between total volume of LV scar and Tpec (r=0.03, p= 0.86), QTc (r=0.26, p=0.13), QRS duration (r=0.24, p=0.16), or LVEF (r=0.13, p=0.47). Similarly, no correlation was found between relative scar volume and Tpec (r=0.011, p=0.95), QTc (r=0.26, p=0.13), QRS duration (r=0.18, p=0.29), or LVEF (r=0.07, p=0.68).

ConclusionIn patients without CAD, scar on CMR correlates with the ECG repolarization indices Tpe and QT, but not with Tpec, QTc, QRSd or LVEF.

Honorable Mention





SATURDAY, OCT. 27, 20182:15pm-3:00pm

Fellows JeopardyLouisiana Ballroom

JEOPARDY CONTESTANTS

LOUISIANA HEALTH – NEW ORLEANSSolomon Seifu, MDAla Mohsen, MDMehnaz Rahman, MD

LOUISIANA HEALTH – SHREVEPORT Khagendra Dahal, MDAditya Hendrani, MDParinita Dherange, MD

Tulane School of MedicineRohit Maini, MDTariq Yousuf, MDKarnika Ayinapudi, MD

Ochsner Medical CenterVinod Chainani, MDAdam Harless, MDMadhav Upadhyaya, MD

Moderator: David Daly, MD, FACCJudge: Achal Sahai MD, FACC

Fellows





PLATINUM SPONSORAbbott

Medtronic

SILVER SPONSOREdwards Lifescience

GE Healthcare

BRONZE SPONSORBlue Cross Blue Shield of Louisiana

Lantheus Medical ImagingZoll Lifevest

The Louisiana Chapter of the American College of Cardiology

would like to thank the following exhibiting companies:

Exhibitors

Abbott

Abiomed

Akcea Therapeutics

Alnylam Pharmaceuticals

Amgen

Astra Zeneca

Biotronik

Blue Cross Blue Shield of Louisiana

Boston Scientific Corporation

Bracco Diagnostics Inc

Edwards Lifescience

GE Healthcare Life Sciences

Hitachi Healthcare

Houston Methodist JC Walter Jr. Transplant Center

Janssen Pharmaceuticals

Lantheus Medical Imaging

Medtronic Inc.

Novartis Pharmaceuticals

Ochsner Health Care

Pfizer

Siemens Healthineers

Zoll Lifevest





OFFICERS

Sangeeta Shah, MD, FACCGovernor/President

Jherie Ducombs, MD, FACCSecretary/Treasurer

Frank Smart, MD, FACCPast President

COUNCILORS

Daniel Morin, MD, MPH, FACCResearch

Pradeep Nair, MD, FACCPVD

Hamang Patel, MD, FACCHeart Failure/pHTN

Peter Fail, MD, FACCInterventional Cardiology/Structural Heart

Kenneth Civello, MD, FACCArrhythmia

Kalgi Modi, MBBS, FACCProgram Director At Large

Michael White, MD, PhD, FACCCongenital Heart Disease – Peds

Thomas Young, MDCongenital Heart Disease – ACHD

Sangeeta Shah, MD, FACCImaging

Murtuzza “Zee” Ali, MD, FACCAdvocacy At Large

Jherie Ducombs, MD, FACCWomen in Cardiology Chair

David Daly, MD, FACCEarly Career

Merrill Stewart, MDEarly Career

FITS

Madhav Upadhyaya, MDOchsner Health Systems

Rahman Mehnaz, MDLSU Health – New Orleans

Dahal Khagendra, MDLSU Health – Shreveport

John Moscona, MDTulane School of Medicine

RESIDENTS

Naga Sai Shravan Turaga, MD LSU Health – Lafayette

Christen Harris, MDRyley McPeters, MD LSU Health – New Orleans

Parker LaVigne, MDLSU Health – Shreveport

Tripti Gupta, MDRaja Sinha, MD Ochsner Health System

Mike Zimmerman, MDTulane School of Medicine

MEDICAL STUDENTS

Christen HarrisRyley McPetersLSU Health – New Orleans

OPEN LSU Health – Shreveport

Evan O’KeefeOchsner Health Systems

Chad BecnelTulane School of Medicine

CV TEAM

Kristin Dupre, Pharm DMoriah Richie, PA

CV ADMIN

Todd Mule CV Administrator

COMMITTEES

Imaging Society of LouisianaChair: Elizabeth McIlwain ACS, RCS, FASE

Women in CardiologyChair: Jherie Ducombs, MD, FACC

AdvocacyChair: Murtuzza “Zee” Ali, MD, FACC

Early CareerCo-Chair: David Daly, MD, FACCCo-Chair: Merrill Stewart, MD

LA-ACC Leadership





Stay Connected!

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@LACVIMAGING

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@LA_ACC

#cardio18

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Go to accscientificsession.org/science for more information!©2018, American College of Cardiology. A19024

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AugUST 28 - OctOBER 16Submit Abstracts & Cases

OctOBER 24 - DecEMBER 5Submit Late-Breaking Clinical Trials

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